Evaluation of adolescent pregnancies in terms of maternal and perinatal risks

Objective: We aimed to evaluate adolescent pregnancy rates and both maternal and perinatal adverse pregnancy outcomes in a secondary care public hospital. Methods: Maternal and perinatal pregnancy outcomes of pregnant women of adolescent age who applied to a secondary level public hospital between June 2018 and March 2021 were evaluated. The study was started with 1803 patients. After the exclusion criteria, the study was continued with 1753 patients. Results: When the parameters that are significant in the binary analysis are analyzed by logistic regression analysis; 2.13-fold the risk of preterm birth (CI: 1.319–4.625), 1.621-fold the risk of premature rupture of membranes (CI: 1.461–2.328), 2.412-fold the risk of low birth weight (CI: 2.894–4.297), and 1.768 fold the need for NICU (CI: 1.013–2.121) were observed to increase. Conclusion: Negative characteristics of adolescent pregnancies should also be taken into account while developing health policies in the coming years. Poor outcomes of adolescent pregnancies should be transferred to both healthcare professionals and society, and adolescent pregnancies should be reduced

The nightmare of obstetricians — the placenta accreta spectrum in primiparous pregnant women

Objectives: The incidence of PAS is increasing day by day as a life-threatening condition. The purpose of the present study was to determine the factors affecting PAS formation in primiparous pregnant women and to define possible risk factors for the mother and the baby. Material and methods: Bursa Yüksek İhtisas Training and Research Hospital, department of obstetrics and gynecology, Bursa, Turkey, between June 2016 and December 2020. A total of 58,895 patients were included in the study. After the exclusion criteria, the study was continued with 27 primiparous PAS and 54 non-primiparous PAS patients. The primary purpose is to evaluate PAS risk factors. The secondary aim is to examine maternal and neonatal characteristics. Result:When the parameters that are significant in terms of PAS risk factors were analyzed by Logistic Regression Analysis, it was found that the increase in age also increased the development of PAS 1.552 times (95% CI: 1.236–1.948) and a history of abortion was 7.928. times (95% CI: 1.408–44.654) and 11,007 times (95% CI: 2.059–58.832) with history of myomectomy; postoperative HB values (p < 0.001), an estimated amount of bleeding (p < 0.001), need for transfusion (p = 0.002), and use of drains (< 0.001) were statistically significant different between two groups. When the neonatal results between patients with and without PAS were examined, birth weight (p < 0.001) and gestational week (< 0.001) were statistically significant. Conclusions: PAS does not occur only in multiparous patients who have a history of previous cesarean section. It may also occur in primiparous patients and is a life-threatening condition

Adolescent pregnancies: complications, birth outcomes and the possible solutions

Objectives: In this study we aim to evaluate antenatal, perinatal and postnatal outcomes and complications of adolescent pregnancies, as well as to discuss the social and psychological consequences of these pregnancies. Material and methods: We compare a total of 243 pregnant women at age 14–18 years to a vast control group at age 19–36 who all delivered at Bursa Yüksek Ihtisas Training and Research Hospital between years 2005–2014. Results: Antenatal care (folic acid supplementation, pre-conception counseling) was significantly higher in adolescent pregnancy group. Unplanned pregnancy rate was significantly higher in in study group (p < 0.001). Preterm delivery (before 37th week) ratio was statistically higher in pregnancy complications. Conclusions: Adolescent pregnancy is a social entity which should be regulated and prevented by legal measures. Planned pregnancies should be promoted and the public should be educated and informed about the Hazards of adolescent pregnancies. Press institutions, public broadcasting services support the efforts to decrease adolescent pregnancies

Hysteroscopic assessment of postmenopausal endometrial thickening

Introduction: Endometrial thickness is measured by transvaginal sonography and thickening indicates an increased risk of malignancy or other pathology (hyperplasia or polyp) in the postmenopausal period. The main screening methods for the uterine cavity are dilatation and curettage, and hysteroscopy. We sought to correlate hysteroscopic and pathological findings in asymptomatic postmenopausal women with sonographically thickened endometrium (> 5 mm) in this study. Material and methods : This retrospective cross-sectional study involved case records of 197 women who have thickened (> 5 mm) endometrium in the postmenopausal period. All these women underwent hysteroscopy with diagnostic dilatation and curettage between January 2012 and January 2013 at the Bursa Zübeyde Hanım Maternity Hospital. Sensitivity, specificity, positive, negative predictive values and p value of hysteroscopy were calculated. Dilatation and curettage was set as the gold standard. Results : For the evaluation of postmenopausal thickened endometrium, hysteroscopy revealed sensitivity, specificity, positive predictive value and negative predictive value as 76.4%, 76.9%, 73.1%, 79.8%, respectively. Conclusions : Hysteroscopy is a fast and accurate technique in evaluation of the intrauterine space occupying lesions (polyp, fibroid) but only moderate for endometrial hyperplasia. Hysteroscopic view combined with direct biopsy could be a gold standard for endometrial assessment

Factors influencing cosmetic results after breast conserving management (Turkish experience)

We aimed to determine predictive factors affecting cosmetic results after breast conserving management in breast cancer. Data on 96 patients with 97 breast cancer cases, who had been admitted to Uludag University M.A. Radiotherapy Center between October 1995 and December 1998 and managed with breast-conserving treatment, were analysed to determine the factors affecting cosmetic outcome, Possible factors affecting cosmesis were grouped as patient-related. tumor-related and treatment-related. Mann-Whitney U test was used in univariate analyses whereas logistic regression was used in multivariate analyses. Median follow-up time was 29.5 months ranging between 11 and 53 months and median age at admission was 50 (range 22-84). Cosmetic results were grouped in five categories; excellent; good; fair; poor and, very poor, using criteria, such as presence of fibrosis, telangiectasia. shape of breast, asymmetry, status of areola, pigmentation. Treated breasts were scored by the patients. three radiation oncologists and a breast surgeon independently. In the analysis performed using scores given by the patients, cases with scores 3 and above (unsatisfactory) were compared with cases with scores below 3 (satisfactory). Eighty-two patients (84%) considered cosmetic result as satisfactory (excellent/good) whereas 15 patients (16%) considered unsatisfactory (fair/poor/very poor). In univariate analysis using Mann Whitney U test, type of surgery (P = 0.0655) was the statistically significant factors affecting cosmetic results. In multivariate analysis using logistic regression, tumor quadrant (P = 0.0060) and elapsed radiation therapy days (P = 0.0090) were the most significant factors. Median values were taken into consideration for the scores given by the physicians and cases with scores 3 and above (unsatisfactory) were compared with cases with scores below 3 (satisfactory). Eighty-two cases were evaluated as satisfactory (84%) whereas 15 cases were unsatisfactory (16%). In this set of data, patient age (P=0.0144), menopausal status (P=0.0111), institution which surgery was performed (P=0.0045), type of surgery (P = 0,0044), placement of metallic clips (P = 0.0083) and skin fibrosis (P = 0.038) were found to be significant in univariate analysis using Mann-Whitney U test. In multivariate analysis using logistic regression, institution where surgery took place (P=0.0015), menopausal status (P=0.0087) and telangiectasia (P=0.0657) were the most significant factors

Tamoksifen kullanımında kalın endometriumun değerlendirilmesi

Amaç: Tamoxifen kullanımına bağlı kalınlaşmış endometriumun değerlendirilmesinde histeroskopinin yerini belirlemek. Gereç ve Yöntemler: Tamoxifen kullanımı olan hastalar ilk basamakta trans-vajinal ultrason (TVUS) ile değerlendirildi. Endometrial kalınlaşma (5 mm) saptanan hastalar histeroskopi ve dilatasyon-küretaja (D&C) yönlendirildi. Çalışmaya östrojen reseptör pozitif meme kanseri olup en az 1 yıldır 20 mg/gün Tanoxifen kullanan 103 hasta üzerinde yapıldı. TVUSda endometrial kalınlaşma (5 mm) saptanan hastalar histeroskopik biyopsi ve dilatasyon-küretaja yönlendirildi. Endometrial kalınlık saptanan hastaların D&C ve histeroskopik biyopsi sonuçları değerlendirildi. Bulgular: Tamoxifen kullanan 103 hastanın 59 tanesinde endometrial kalınlaşma saptandı. Bu hastaların 35 tanesinde D&Cde materyal elde edilerek patolojik tanı kondu. Materyal elde edilemeyen 24 hasta histeroskopik biyopsiye yönlendirildi. Bu hastaların 11 (%45,8) tanesinde endometrial polip saptandı. Sonuç: Tamoxifen kullanımında endometrial kalınlık saptanan hastalarda D&C tek başına yeterli görünmemektedir. Histeroskopik biyopsi bu hastaların değerlendirilmesinde ilk sırada düşünülmelidir. J Turk Soc Obstet Gynecol 2014;4:215-8Objective: Aim of this study was to evaluate role of hysteroscopy in thickened endometrium (>5 mm) associated with tamoxifen therapy. Materials and Methods: We performed dilatation and curettage (D&C) and hysteroscopic biopsy to patients for evaluation of thickened endometrium in tamoxifen therapy. One hundred and nine asymptomatic patients with estrogen receptor positive breast cancer treated with tamoxifen 20 mg daily. We performed hysteroscopic biopsy or D&C to patients who have thickened endometrium at transvaginal sonography. We correlate pathology report results of D&C and hysteroscopic biopsy. Results: Fifty-nine of 103 patients have thickened endometrium.Thirty-five of 59 patients diagnosed with D&C (19 inactive endometrium, 15 endometrial polyp, 1 endometrial hyperplasia). D&C couldnt get material 24 of these patients. Hysteroscopic biopsy diagnosed endometrial polyp 11 (45.8%) of these patients. Conclusion: We can state that D&C does not seem accurate enough for detection of intrauterin pathologies in thickened endometrium associated with tamoxifen therapy. We therefore believe it is reasonable to perform hysteroscopic biopsy in asymptomatic tamoxifen treated patients who have thickened endometrium. J Turk Soc Obstet Gynecol 2014;4:215-

Gestational Diabetes: Screening, Management, Timing of Delivery

Tokgoz, Vehbi Yavuz/0000-0002-4113-385XWOS: 000218724000007Gestational diabetes mellitus (GDM) is a pancreatic function insufficiency to overcome the insulin resistance associated with the pregnant state. The prevalence of GDM is about 2-5 % of normal pregnancies. To prevent the adverse outcome for the mother, the fetus, and neonatal period, detection of GDM is important. Screening methods vary by clinics. Screening can either be selective, based upon risk stratification or universal. Timely testing enables the obstetrician to assess glucose tolerance in the presence of the insulin-resistant state of pregnancy and permits treatment to begin before excessive fetal growth has occurred. After the diagnosis of GDM, close perinatal surveillance is necessary. The goal of treatment in GDM is to reduce fetal and maternal morbidity and mortality. The exact glucose values needed are still unknown. The decision whether and when to induce delivery depends on gestational age, fetal growth, maternal glucose levels, and Bishop score. Screening, follow-up, and treatment of GDM still have controversies

Population-based cervical screening outcomes in Turkey over a period of approximately nine and a half years with emphasis on results for women Aged 30-34

Sengul, Ilker/0000-0001-5217-0755; Korkmazer, Engin/0000-0001-8318-2329WOS: 000335651200030PubMed: 24716936Purpose: To appraise the frequency of cervical cytological abnormalities in a population at normal risk via analysing the archive records of cytology for the period of approximately 9,5 years, comparing them with patient demographic charecteristics, and discuss the results for women under age of 35. Materials and Methods: A total of 32,578 cases of Pap smears were retrieved and analysed from our archive included the Pap tests performed between January 2001 and April 2010 at the Early Cancer Screening, Diagnosing and Education Center by the consent of three pathologists via utilizing the Bethesda System Criteria 2001 and the results were compared with some demographical characteristics. Results: Our rate of the cervical cytological abnormality was 1.83%, with ASCUS in 1.18%, LSIL in 0.39, HSIL in 0.16%, AGUS in 0.07%, squamous cell carcinoma in 0.02%, and adenoarcinoma in 0.006%. Cytological abnormalities were detected mostly in those with higher age, lower parity, and premenopausal period whereas the smoking status was without influence. Bacterial vaginosis (5.6%) was the most frequent infectious finding (Candida albicans 2.7%; Actinomyces sp. 1.3%; and Trichomonas vaginalis 0.2%) detected on the smears. The rate of abnormal cervical cytology was 9.5% among the women aged between 30-34. Conclusions: Early detection of the cervical abnormalities by means of the regular cervical cancer screening programmes is useful to attenuate the incidence, mortality, and morbidity of cervical cancer. Our prevalence of the cytological abnormalities was much lower than the one in Western populations in general but very similar to those reported from other Islamic countries that may be explained by the conservative lifestyle and the lower prevalence of HPV in Turkey. A remarkable rate of abnormal cervical cytology of women aged 30-34 was pointed out in the present study

Serum Lipid Profile and Inflammatory Status in Women with Gestational Diabetes Mellitus

Korkmazer, Engin/0000-0001-8318-2329WOS: 000382752700007Objective: Gestational diabetes mellitus (GDM) is associated with increased risk of postpartum type 2 diabetes mellitus and cardiovascular risk factors such as obesity, hypertension, dyslipidemia, and systemic inflammation. We aimed to evaluate the lipid profile and inflammatory status assessed by high sensitive C-reactive protein (hsCRP) and TNF-alpha levels. We also evaluated insulin resistance for all participants. Methods: This study was performed including the pregnant with normal glucose challenge test (GCT) and normal glucose tolerance (NGT) (n: 20), abnormal GCT and NGT (n: 27), and GDM (n: 29) defined by Carpenter and Coustan criteria. Results: In our study, we could not find significantly differences by means of hsCRP levels and lipid profile parameters between groups. But, TNF-alpha levels increased significantly in the GDM or abnormal GCT NGT groups as compared to the normal GCT NGT group. hsCRP was correlated independently with LDL-cholesterol and parity in the abnormal GCT NGT group and atherogenic index of the plasma (AIP) in GDM group. In addition, there was not an independent relationship between AIP and hsCRP in the GDM group when multiple linear regression analysis was performed after adjustment for maternal age was evaluated at 29.49 years. Conclusion: In conclusion, gestational insulin resistance was apparently associated with TNF-alpha, whereas dyslipidemia was slightly associated with hsCRP because of the possible effects of maternal age on lipid markers